HIV Prevalence, Risks for HIV Infection, and Human Rights among MSM in Malawi, Namibia, and Botswana

In the generalized epidemics of HIV in southern Sub-Saharan Africa, men who have sex with men have been largely excluded from HIV surveillance and research. Epidemiologic data for MSM in southern Africa are among the sparsest globally, and HIV risk among these men has yet to be characterized in the majority of countries.

via PLoS ONE, by:

Stefan Baral^1,7*, Gift Trapence², Felistus Motimedi³, Eric Umar⁴, Scholastika Iipinge⁵, Friedel Dausab⁶, Chris Beyrer¹

1 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America, 2 Center for the Development of People, Blantyre, Malawi, 3 Botswana Network on Ethics, Law, and HIV/AIDS, Gaborone, Botswana, 4 Department of Community Health, University of Malawi,-College of Medicine, Blantyre, Malawi, 5 HIV/AIDS Coordinator, University of Namibia, Windhoek, Namibia, 6 The Rainbow Project, Windhoek, Namibia, 7 Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada

INTRO:

While southern Sub-Saharan Africa has long been the most HIV/AIDS affected region globally, it has been arguably the most understudied for the risk of HIV associated with male to male sexual contact The crude characterization of these epidemics as generalized and driven by heterosexual risks has obscured the component of Southern Africa's epidemics which may be due to risks among men who have sex with men (MSM). The marked homophobia, discrimination, and criminalization of same-sex behavior in much of Africa have likely limited investigation among these men. Data regarding the prevalence of MSM in the region are among the sparsest globally, but there is evidence that male to male sexual contact is a reality on this continent as on all others To date, there have been published papers from only Senegal and Kenya describing HIV risk and prevalence among MSM in Africa . However, a systematic review found studies from other African countries either not presenting HIV prevalence data or studies that to-date have only been presented as abstracts. These studies suggest that African MSM are at substantial risk for HIV infection, and that they have been markedly underserved and marginalized. Reported HIV rates, where available, have been higher than among other men of reproductive age in the same populations, yet these men tend to have limited knowledge of the health related risks of anal intercourse. The lack of data on MSM and HIV are paradoxically the most marked for the world's highest prevalence zone; the southern region of Sub-Saharan Africa. No published studies have reported HIV prevalence among MSM in Namibia, Malawi, and Botswana, three profoundly HIV/AIDS affected southern states. MSM have not been included in the HIV/AIDS strategies in these countries and same sex behavior among consenting adults is criminalized in all three states in 2008.

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